Federal health officials Monday targeted drug makers and companies that negotiate drug benefits as they provided more details to back up President Trump's plan to lower drug prices. Health and Human Services Secretary Alex Azar bristled Monday at criticism that the plan Trump announced Friday does not go far enough. He said the plan has more teeth than critics claimed. But some consumer advocates weren't convinced.

"It’s still not clear all of this will make prices come down or how long it will take," says cancer patient David Mitchell, founder of the non-profit Patients for Affordable Drugs. "But they are adding a bit more flesh on the bones."

Azar said Trump's 2016 campaign pledge to have the federal Medicare program negotiate directly with drug companies would not work because it would deny access to medicines "through rationing or setting prices," which he called a "move toward socialized medicine."

Trump stopped short of proposing direct negotiations Friday, opting for a plan that would involve pharmacy benefit managers, such as Express Scripts and CVS Caremark, negotiating for the prices for drugs administered in doctor's offices, hospitals and outpatient clinics, which are those covered under Medicare Part B. PBMs currently negotiate the drugs in Medicare Part D, which covers those bought at drug stores.

While this move by the administration could lower prices, at least in theory, it could in practice lead to higher out of pocket costs for consumers, says Mitchell, who has the incurable blood cancer multiple myeloma. That's because there are co-payments for Medicare Part D drugs and no cap on how much patients could owe a year.

David Mitchell, founder of Patients for Affordable Drugs, is shown getting an infusion of drugs for his incurable blood cancer, multiple myeloma, last year.(Photo: Courtesy of Patients for Affordable Drugs)

Additional details included:

• Shaming or at least transparency. Starting Thursday, the Food and Drug Administration plans to begin publishing the names of brand-name drug companies that refuse to provide samples to generic companies so they can begin to develop their lower-priced alternatives. FDA Commissioner Scott Gottlieb said the move wasn't shaming, but rather transparency. Whatever it's called, Mitchell questions how much impact it will have on companies like Celgene, which makes one of the costliest cancer drugs on the market.

"It’s hard to imagine shaming will be enough when there is $7 billion a year in revenue at stake for a drug like Celgene's Revlimid," says Mitchell. "I fear the companies will be happy to be shamed all the way to the bank.”

• Cutting rebates? PBMs earn rebates, along with fees, for negotiating drug prices paid by insurance companies, employers and the federal government. The rebate system for the government contains a provision, that keeps these rebates from violating anti-kickback rules. Azar says he could remove that exemption with his pen and the Justice Department."It could be modified the same way it was created," said Azar, who said it is a "very perverse Incentive" as list prices go up, so do rebates.

• Bigger penalties. Congress put a cap on how much drug companies have to pay when they increase Medicaid drug prices above the rate of inflation and Azar said HHS is considering overturning it. “The entire system encourages higher and higher list prices,” says Azar.

Jackie Trapp, a former Wisconsin high school teacher who also has multiple myeloma, called transparency a "step in the right direction," but was disappointed that the new plan didn't include direct negotiating by Medicare or that "pharmacy benefit managers might be eliminated somehow."

Doug and Jackie Trapp of Muskego, Wisc. are shown during a break from Jackie's chemotherapy in November 2016.(Photo: Family photo)

"I cannot shop around or boycott and big pharma has a stranglehold on Congress and a government sponsored monopoly over life saving drugs for patients like me," says Trapp.

Azar, a former top executive at drug maker Eli Lilly, also distanced himself from the industry his new boss pilloried on Friday. Drug makers have long claimed their prices are justified by their high research-and-development costs. Azar said Monday that simply isn't true.